Fournier gangrene: Difference between revisions
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{{Infobox_Disease | {{Infobox_Disease | ||
| Name = Fournier gangrene | | Name = Fournier gangrene | ||
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| ICD9 = {{ICD9|608.83}} | | ICD9 = {{ICD9|608.83}} | ||
| ICDO = | | ICDO = | ||
| OMIM | | OMIM {{Search infobox}} = | ||
| MedlinePlus = <!-- has no entry --> | | MedlinePlus = <!-- has no entry --> | ||
| MeshID = D018934 | | MeshID = D018934 | ||
}} | }} | ||
==Overview== | ==Overview== | ||
'''Fournier gangrene''' is a type of [[necrosis|necrotizing]] [[infection]] ([[gangrene]]) usually affecting the male [[genital]]s. It is a type of [[necrotizing fasciitis]]. It was first described by Baurienne in 1764 and is named after a French [[venereology|venereologist]], Jean-Alfred Fournier following five cases he presented in clinical lectures in 1883. | '''Fournier gangrene''' is a type of [[necrosis|necrotizing]] [[infection]] ([[gangrene]]) usually affecting the male [[genital]]s. It is a type of [[necrotizing fasciitis]]. It was first described by Baurienne in 1764 and is named after a French [[venereology|venereologist]], Jean-Alfred Fournier following five cases he presented in clinical lectures in 1883. | ||
==Aetiology== | ==Historical Perspective== | ||
==Classification== | |||
==Pathophysiology== | |||
==Causes== | |||
===Aetiology=== | |||
In the majority of cases Fournier gangrene is a mixed infection caused by both [[aerobic]] and [[anaerobic]] bacteria.<ref>{{cite journal |author=Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K |title=Fournier's gangrene and its emergency management |journal=Postgrad Med J |volume=82 |issue=970 |pages=516-9 |year=2006 |id=PMID 16891442}}</ref> | In the majority of cases Fournier gangrene is a mixed infection caused by both [[aerobic]] and [[anaerobic]] bacteria.<ref>{{cite journal |author=Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K |title=Fournier's gangrene and its emergency management |journal=Postgrad Med J |volume=82 |issue=970 |pages=516-9 |year=2006 |id=PMID 16891442}}</ref> | ||
==Incidence== | ==Differentiating {{PAGENAME}} from Other Diseases== | ||
==Epidemiology and Demographics== | |||
===Incidence=== | |||
Only 600 cases of Fournier gangrene were reported in the world literature in the ten years since 1996, with most patients in their 60s or 70s with other concurrent illnesses.<ref>{{cite journal |author=Vaz I |title=Fournier gangrene |journal=Trop Doct |volume=36 |issue=4 |pages=203-4 |year=2006 |id=PMID 17034687}}</ref> However, Fournier's gangrene is not a reportable illness, and the condition is not uncommon, especially among diabetic individuals. A similar infection in women has been occasionally described.<ref>{{cite journal |author=Herzog W |title=[Fournier gangrene--also in females?] |journal=Zentralbl Chir |volume=112 |issue=9 |pages=564-76 |year=1987 |id=PMID 2956804}} </ref> | Only 600 cases of Fournier gangrene were reported in the world literature in the ten years since 1996, with most patients in their 60s or 70s with other concurrent illnesses.<ref>{{cite journal |author=Vaz I |title=Fournier gangrene |journal=Trop Doct |volume=36 |issue=4 |pages=203-4 |year=2006 |id=PMID 17034687}}</ref> However, Fournier's gangrene is not a reportable illness, and the condition is not uncommon, especially among diabetic individuals. A similar infection in women has been occasionally described.<ref>{{cite journal |author=Herzog W |title=[Fournier gangrene--also in females?] |journal=Zentralbl Chir |volume=112 |issue=9 |pages=564-76 |year=1987 |id=PMID 2956804}} </ref> | ||
In Turkey it was reported that 46% of patients had [[diabetes mellitus]]<ref name="Yanar2006">{{cite journal |author=Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, Baspinar I |title=Fournier's gangrene: risk factors and strategies for management |journal=World J Surg |volume=30 |issue=9 |pages=1750-4 |year=2006 |id=PMID 16927060}}</ref> whilst other studies have identified approximately a third of patients having either diabetes, alcoholism or malnutrition, and 10% having medical immunosuppression (chemotherapy, steroids, malignancy).<ref>{{cite journal |author=Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcýn O |title=Fournier's gangrene: report of thirty-three cases and a review of the literature |journal=Int J Urol |volume=13 |issue=7 |pages=960-7 |year=2006 |id=PMID 16882063}}</ref> | In Turkey it was reported that 46% of patients had [[diabetes mellitus]]<ref name="Yanar2006">{{cite journal |author=Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, Baspinar I |title=Fournier's gangrene: risk factors and strategies for management |journal=World J Surg |volume=30 |issue=9 |pages=1750-4 |year=2006 |id=PMID 16927060}}</ref> whilst other studies have identified approximately a third of patients having either diabetes, alcoholism or malnutrition, and 10% having medical immunosuppression (chemotherapy, steroids, malignancy).<ref>{{cite journal |author=Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcýn O |title=Fournier's gangrene: report of thirty-three cases and a review of the literature |journal=Int J Urol |volume=13 |issue=7 |pages=960-7 |year=2006 |id=PMID 16882063}}</ref> | ||
== | ==Risk Factors== | ||
== | ==Screening== | ||
====Genitourinary system==== | ==Natural History, Complications, and Prognosis== | ||
==Diagnosis== | |||
===Diagnostic Criteria=== | |||
===History and Symptoms=== | |||
===Physical examination=== | |||
====Gallery==== | |||
=====Genitourinary system===== | |||
<gallery> | <gallery> | ||
| Line 46: | Line 69: | ||
</gallery> | </gallery> | ||
==Medical Therapy== | ===Laboratory Findings=== | ||
===Imaging Findings=== | |||
===Other Diagnostic Studies=== | |||
==Treatment== | |||
===Medical Therapy=== | |||
Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if [[sepsis]] is already present at the time of initial hospital admission.<ref name="Yanar2006"/> | Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if [[sepsis]] is already present at the time of initial hospital admission.<ref name="Yanar2006"/> | ||
===Antimicrobial Therapy=== | ====Antimicrobial Therapy==== | ||
* Fournier gangrene<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | * Fournier gangrene<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | ||
:* '''If caused by streptococcus species or clostridia''' | :* '''If caused by streptococcus species or clostridia''' | ||
| Line 59: | Line 89: | ||
::* Preferred regimen: [[vancomycin]] {{or}} [[daptomycin]] | ::* Preferred regimen: [[vancomycin]] {{or}} [[daptomycin]] | ||
== | ===Surgery=== | ||
===Prevention=== | |||
==External links== | ==External links== | ||
* {{WhoNamedIt2|synd|2521|Fournier gangrene}} and {{WhoNamedIt|doctor|2209|Jean Alfred Fournier}} | * {{WhoNamedIt2|synd|2521|Fournier gangrene}} and {{WhoNamedIt|doctor|2209|Jean Alfred Fournier}} | ||
[[Category: | ==References== | ||
{{reflist|2}} | |||
[[Category:Dermatology]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 11:28, 3 August 2016
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Steven C. Campbell, M.D., Ph.D.; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [1].
| Fournier gangrene | |
| ICD-10 | N49.8 (ILDS N49.81), N76.8 |
|---|---|
| ICD-9 | 608.83 |
| DiseasesDB | 31119 |
| MeSH | D018934 |
Overview
Fournier gangrene is a type of necrotizing infection (gangrene) usually affecting the male genitals. It is a type of necrotizing fasciitis. It was first described by Baurienne in 1764 and is named after a French venereologist, Jean-Alfred Fournier following five cases he presented in clinical lectures in 1883.
Historical Perspective
Classification
Pathophysiology
Causes
Aetiology
In the majority of cases Fournier gangrene is a mixed infection caused by both aerobic and anaerobic bacteria.[1]
Differentiating Fournier gangrene from Other Diseases
Epidemiology and Demographics
Incidence
Only 600 cases of Fournier gangrene were reported in the world literature in the ten years since 1996, with most patients in their 60s or 70s with other concurrent illnesses.[2] However, Fournier's gangrene is not a reportable illness, and the condition is not uncommon, especially among diabetic individuals. A similar infection in women has been occasionally described.[3]
In Turkey it was reported that 46% of patients had diabetes mellitus[4] whilst other studies have identified approximately a third of patients having either diabetes, alcoholism or malnutrition, and 10% having medical immunosuppression (chemotherapy, steroids, malignancy).[5]
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical examination
Gallery
Genitourinary system
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if sepsis is already present at the time of initial hospital admission.[4]
Antimicrobial Therapy
- Fournier gangrene[6]
- If caused by streptococcus species or clostridia
- Preferred regimen: Penicillin G
- Polymicrobial
-
- MRSA (methicillin resistant staphylococcus aureus) suspected
- Preferred regimen: vancomycin OR daptomycin
Surgery
Prevention
External links
References
- ↑ Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K (2006). "Fournier's gangrene and its emergency management". Postgrad Med J. 82 (970): 516–9. PMID 16891442.
- ↑ Vaz I (2006). "Fournier gangrene". Trop Doct. 36 (4): 203–4. PMID 17034687.
- ↑ Herzog W (1987). "[Fournier gangrene--also in females?]". Zentralbl Chir. 112 (9): 564–76. PMID 2956804.
- ↑ 4.0 4.1 Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, Baspinar I (2006). "Fournier's gangrene: risk factors and strategies for management". World J Surg. 30 (9): 1750–4. PMID 16927060.
- ↑ Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcýn O (2006). "Fournier's gangrene: report of thirty-three cases and a review of the literature". Int J Urol. 13 (7): 960–7. PMID 16882063.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.